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Introduction

The availability of adequate number of health professionals to manage health programmes
alone may not necessarily lead to their successful implementation. The competencies
and commitment of these professionals also need to be ensured. One of the biggest
challenges, in this regard, has been poor capacity building at every rung of health
care. The situation is further worsened by a shortfall in the human resource, especially
specialists. There has often been a mismatch between the number of required and sanctioned
posts and also between sanctioned and actual number of medical-officers and specialists
posted in a health facility.

Methods

In order to study and understand the issues of optimal workforce management and human
resource development, a study on determinants of workforce availability and performance
of specialists and general duty medical officers was conducted in Rajasthan. The study
was done in association with the National Health Systems Resource Centre. The study
aimed at assessing the gaps between the services expected and those provided at a
facility level, along with analyzing the recruitment, compensation, transfer and training
policy of medical officers and specialists.

On the basis of discussions with the National Health System Resource Centre and the
State Health Department, four districts were selected on the basis of the Human Development
Index (HDI). The institutions surveyed were District Hospital, Sub-Divisional Hospital,
Community Health Centres and Primary Health Centres. In addition to an institutional
survey, 40 doctors (30 general duty medical officers and 10 specialists) were also
interviewed on a pre-designed format. The findings were validated through discussions
with the state government.

Results

It was found that one-fifth of the sample doctors had completed 25 years of service.
Of all the doctors in the sample, 18% were lady doctors. A large number of doctors
employed in the public health system hailed from rural background and expressed an
inclination towards receiving specialized training. It was found that the medical
personnel were not being treated equally in terms of transfers. A reasonably high
degree of dissatisfaction was found among the doctors in terms of their remuneration.
Only 11.25% doctors got promoted within 5 to 10 years of their joining the state services.

Regarding the perception on availability of work space, instruments, drugs, supporting
staff, logistics and community support, the specialists were found to be satisfied
but in case of generalists, only 64% are satisfied.

The survey showed that most of the infrastructural facilities including essential
equipments were available in all the district hospitals and community health centres,
barring a few in the latter. However, in the primary health centres, such facilities
were not sufficiently available.

The results indicate that posting, perception regarding specialization, hierarchical
satisfaction, quality of facilities and services and human resource policy are the
determinants for the workforce availability.

Discussions

The results of the study call for a need for better planning and management of human
resource policy. Such planning should ensure transparency in deployment, transfers
and promotions of doctors in the field. Increased and improved facilities should be
made available to doctors in peripheral health institutions. Specifically, this would
call for placing sufficient nursing staff, making laboratory technicians available,
equipping with sufficient material like syringes, needles, cold chain equipments and
surgical material.

Competing interests

None declared

Funding statement

The study was funded by the National Health Systems Resource Centre, New Delhi.